BACKGROUND AND OBJECTIVES: Despite aggressive medical therapy and previous endoscopic sinus surgery, there are a subset of patients suffering from recalcitrant, persistent chronic isolated maxillary sinusitis which results from impaired mucocilliary clearance caused by long-standing inflammation. The corresponding patients underwent our newly devised Modified Inferior Meatal Mega-Antrostomy (Modified IMMA). The objective of this study was to review the clinical efficacy and complication after Modified IMMA in patients who had suffered from intractable maxillary sinusitis after endoscopic sinus surgery. SUBJECTS AND METHOD: Fourteen patients suffering from recalcitrant chronic isolated maxillary sinusitis underwent Modified IMMA between May 2010 and April 2013. The mean follow-up period was an average of about 13 months and regular intervals of postoperative 3-, 6-, 9-, 12-months were set. A retrospective review was performed to analyze the preoperative & postoperative Visual Analogue Scale score (VAS score) and Lund-Kennedy endoscopy score at each interval. VAS scores and endoscopic findings were processed statistically at the time of third postoperative month. The exclusion criteria were an obstructed ostiums, osteitis, systemic disease such as Ig A/G immunodeficiency, primary ciliary dyskinesia. RESULTS: The postoperative VAS scores and Lund-Kennedy scores, when compared with those prior to Modified IMMA, decreased from 16.5 to 2.5 and 5.0 to 1.0, respectively. Also, there was no serious complication or recurrence associated with the procedures. CONCLUSION: Our newly devised Modified IMMA could be a much effective option for surgical treatments in patients with recalcitrant chronic isolated maxillary sinusitis.
Endoscopy ; Follow-Up Studies ; Humans ; Inflammation ; Maxillary Sinus ; Maxillary Sinusitis ; Osteitis ; Recurrence ; Retrospective Studies ; Stress, Psychological

Antihypertensive effect of angiotensin converting enzyme(ACE) inhibitor Captopril was studied in 34 cases of essential hypertension. A single oral dose of 50mg Captopril was administered daily and blood pressure was followed every 2 weeks. Diuretics were added to patients who responded inadequately after 2 weeks of Captopril single treatment. Alpha-blocker, beta-blocker or calcium channel-blocker was added to patients who responded inadequately after another 2 weeks of Captopril and diuretics combined treatment. In 5 cases, Captopril was raised to 100mg and further antihypertensives were added to unresponded 3 cases. The resuts were as follows; 1) In 15 patients, blood pressure dropped from 170.3+/-10.5mmHg/108.7+/-6.1mmHg to 148.3+/-4.4mmHg/93.3+/-3.7mmHg after 8 weeks of Captopril 50mg single therapy. 2) Hydrochlorothiazide 25mg was added to non-responders, and blood pressure dropped from 180+/-6.7mmHg/111.1+/-6.2mmHg to 155.0+/-15.0mmHg/106.2+/-8.7mmHg in 9 of 19 patients after 8 weeks of combined treatment. 3) Alpha-blocker, Beta-blocker or calcium channel blocker was added to 10 non-responders to Captopril-hyprochlorothiazide combination therapy, and blood pressure dropped from 189.0+/-27mmHg/116+/-10mmHg to 137.8+/-15.5mmHg/88.5+/-10.2mmHg after 8 weeks. 4) Increase of captopril from 50mg to 100mg in 5 random nonresponder cases of Captopril single treatment lowered blood pressure from 168.0+/-13.6mmHg/107.1+/-6.4mmHg to 161+/-15.2mmHg/99+/-8.8mmHg after 2 weeks. 5) Heart rate, and serum creatinine, electrolytes and lipid levels showed no significant interval change. 6) Six patients complained of dry cough and one patient complained of poor appetite but no other clinically significant complications were noted during Captopril treatment.
Angiotensins ; Antihypertensive Agents ; Appetite ; Blood Pressure ; Calcium ; Calcium Channels ; Captopril* ; Cough ; Creatinine ; Diuretics ; Electrolytes ; Heart Rate ; Humans ; Hydrochlorothiazide ; Hypertension

Recent evidence shows that transcriptional silencing as a consequence of hypermethylation of CpG islands is an important mechanism in the inactivation of p16INK4 tumor suppressor gene. This study is designed to clarify the significance of p16INK4 hypermethylation in 23 cases of glioblastomas (GBMs) by methylation-specific polymerase chain reaction (PCR) and p16 immunostaining. Fourteen cases (60.9%) out of 23 GBMs revealed hypermethylation on p16. p16 immunostaining revealed that 13 (93%) of these 14 hypermethylation cases showed complete loss of immunoreactivity and only one (7%) case retained immunoreactivity. Among 9 methylation-negative cases, 4 were immunonegative, which might be related to mutations or deletions other than hypermethylation. The most significant finding was that of 17 cases with immunonegativity, 13 cases (76.5%) showed hypermethylation. We reconfirmed that p16 hypermethylation may be one of the major mechanisms of tumorigenesis of GBMs and the results between the methylation specific-PCR study and p16 immunostaining had a good correlation.
5' Untranslated Regions/metabolism* ; 5' Untranslated Regions/genetics ; Adult ; Antisense Elements (Genetics) ; Brain Neoplasms/pathology ; Brain Neoplasms/genetics* ; Brain Neoplasms/chemistry ; CpG Islands/physiology* ; DNA Methylation* ; Female ; Gene Silencing/physiology ; Glioblastoma/pathology ; Glioblastoma/genetics* ; Glioblastoma/chemistry ; Human ; Male ; Middle Age ; Polymerase Chain Reaction ; Protein p16/genetics* ; Protein p16/analysis

In this study, we determined the effect of 24 different synthetic 4-benzylpiperidine carboxamides on the reuptake of serotonin, norepinephrine, and dopamine (DA), and characterized their structure–activity relationship. The compounds with a two-carbon linker inhibited DA reuptake with much higher potency than those with a three-carbon linker. Among the aromatic ring substituents, biphenyl and diphenyl groups played a critical role in determining the selectivity of the 4-benzylpiperidine carboxamides toward the serotonin transporter (SERT) and dopamine transporter (DAT), respectively. Compounds with a 2-naphthyl ring were found to exhibit a higher degree of inhibition on the norepinephrine transporter (NET) and SERT than those with a 1-naphthyl ring. A docking simulation using a triple reuptake inhibitor 8k and a serotoninorepinephrine reuptake inhibitor 7j showed that the regions spanning transmembrane domain (TM)1, TM3, and TM6 form the ligand binding pocket. The compound 8k bound tightly to the binding pocket of all three monoamine reuptake transporters; however, 7j showed poor docking with DAT. Co-expression of DAT with the dopamine D2 receptor (D2R) significantly inhibited DA-induced endocytosis of D2R probably by reuptaking DA into the cells. Pretreatment of the cells with 8f, which is one of the compounds with good inhibitory activity on DAT, blocked DAT-induced inhibition of D2R endocytosis. In summary, this study identified critical structural features contributing to the selectivity of a molecule for each of the monoamine transporters, critical residues on the compounds that bound to the transporters, and the functional role of a DA reuptake inhibitor in regulating D2R function.

In this study, we determined the effect of 24 different synthetic 4-benzylpiperidine carboxamides on the reuptake of serotonin, norepinephrine, and dopamine (DA), and characterized their structure–activity relationship. The compounds with a two-carbon linker inhibited DA reuptake with much higher potency than those with a three-carbon linker. Among the aromatic ring substituents, biphenyl and diphenyl groups played a critical role in determining the selectivity of the 4-benzylpiperidine carboxamides toward the serotonin transporter (SERT) and dopamine transporter (DAT), respectively. Compounds with a 2-naphthyl ring were found to exhibit a higher degree of inhibition on the norepinephrine transporter (NET) and SERT than those with a 1-naphthyl ring. A docking simulation using a triple reuptake inhibitor 8k and a serotoninorepinephrine reuptake inhibitor 7j showed that the regions spanning transmembrane domain (TM)1, TM3, and TM6 form the ligand binding pocket. The compound 8k bound tightly to the binding pocket of all three monoamine reuptake transporters; however, 7j showed poor docking with DAT. Co-expression of DAT with the dopamine D2 receptor (D2R) significantly inhibited DA-induced endocytosis of D2R probably by reuptaking DA into the cells. Pretreatment of the cells with 8f, which is one of the compounds with good inhibitory activity on DAT, blocked DAT-induced inhibition of D2R endocytosis. In summary, this study identified critical structural features contributing to the selectivity of a molecule for each of the monoamine transporters, critical residues on the compounds that bound to the transporters, and the functional role of a DA reuptake inhibitor in regulating D2R function.

Exclusively dopamine producing retroperitoneal paragangliomas are extremely rare. We have experienced the first Korean case managed successfully based on the proper evaluation. A 26-year-old female patient came to our attention after the accidental detection of an adrenal mass. She had no symptoms and denied any family history. Laboratory evaluations were normal but serum dopamine (425 ng/L) and 24-hour urine dopamine levels (1,565.3 microg/day) were elevated. She underwent laparoscopic right adrenalectomy. Histopathological diagnosis was a paraganglioma. After operation, dopamine levels in serum and 24-hour urine dropped to 0.09 ng/L and 388.4 microg/day. Dopamine producing paraganglioma elicit no clinical symptoms. Only the dopamine level is elevated in serum and 24-hour urine samples. Surgical resection without using preoperative alpha blockage is the treatment of choice. The prognosis for patients with this tumor tends to be poor because the diagnosis is usually delayed due to lack of symptoms.
Adrenal Glands ; Adrenalectomy ; Adrenergic alpha-Antagonists ; Adult ; Dopamine ; Female ; Humans ; Korea ; Paraganglioma ; Pheochromocytoma ; Porphyrins ; Prognosis

Hemophagocytic lymphohistiocytosis(HLH) is a rare and fatal disorder in children. Persistent fever, hepatosplenomegaly and pancytopenia are observed in the most cases with the characteristic change of serum triglyceride, fibrinogen, ferritin and LDH level. CNS manifestation were developed in 50-70% of HLH. 20% of cases revealed seizure and irritability at diagnosis. Abnormalities on brain imaging, such as diffuse white matter abnormalities and necrotic area with parenchymal volume loss appeared to roughly parallel the severity of clinical manifestations. In HLH, EBV is the major triggering agent inducing hemophagocytosis as well as the fulminant course of disease. Many cases of EBV-HLH had monoclonal origin and respond well to etoposide-containing regimens. Early induction of an etoposide based regimen is critical factor in securing long-term survival in patients with EBV-HLH. We report a case that 13 year-old female patient with seizure and loss of consciousness was diagnosed as EBV-HLH and treated with protocol HLH-94 consistd of etoposide, dexamethasone, cyclosporin.
Adolescent ; Central Nervous System ; Child ; Cyclosporine ; Dexamethasone ; Diagnosis ; Etoposide ; Female ; Ferritins ; Fever ; Fibrinogen ; Herpesvirus 4, Human ; Humans ; Lymphohistiocytosis, Hemophagocytic* ; Neuroimaging ; Pancytopenia ; Seizures* ; Triglycerides ; Unconsciousness*

PURPOSE: Surgical excision is the definitive treatment for localized recurrence of papillary thyroid carcinoma. Reoperation for recurrence, however, is challenging and associated with increased operative times and complication rates. For safe and effective reoperation, ultrasound-guided charcoal tattooing localization can be used. The aim of this study was to investigate the feasibility and safety of the ultrasound-guided charcoal tattooing localization. METHODS: Between November 2012 and August 2013, ten patients underwent preoperative charcoal tattooing localization for twelve recurrent lesions. Patient demographics, pathologic features, and operation results were reviewed. RESULTS: The technical success rate of charcoal tattooing was 100%. Eight patients had one recurrent lesion, and two patients had double lesions. Among these 12 recurrent lesions, three (25%) were found in level II, four (33%) in level IV, four (33%) in level VI, and one (8%) was found in the thyroidectomy bed site. The mean size of lesions was 0.87 +/- 0.35 cm. Of these 10 patients, eight patients underwent selective lymph node dissection, one patient underwent modified radical neck dissection, and one patient underwent recurrent mass excision. Transient hypocalcemia developed in one patient, and no recurrent laryngeal nerve palsy occurred. There were no major complications related to the injection of the charcoal. The mean follow-up period after reoperation was 8.6 +/- 2.7 months; in the follow-up ultrasound, there were no remnant lesions in all patients. CONCLUSION: Preoperative ultrasound-guided charcoal tattooing localization for recurrent thyroid cancer appears to be a feasible and safe procedure for reoperation. Further evaluation is warranted in larger patients' cohorts.
Charcoal* ; Cohort Studies ; Demography ; Follow-Up Studies ; Humans ; Hypocalcemia ; Lymph Node Excision ; Neck Dissection ; Operative Time ; Recurrence ; Reoperation ; Tattooing* ; Thyroid Neoplasms* ; Thyroidectomy ; Ultrasonography ; Vocal Cord Paralysis

BACKGROUND: Systemic lupus erythematosus (SLE) is one of chronic autoimmune diseases of which the central pathophysiologic derangement has not been yet established. Recently, it has been suggested that immune-regulatory cells might affect the development of autoimmune diseases such as SLE and RA. NKT cells were reported to be strong candidate for regulatory cells to regulate immune responses in vivo. To elucidate the roles of immune regulatory cells in the pathogenesis of SLE, we investigated the fractional distribution and functional status of NK and NKT cells in peripheral blood mononuclear cells (PBMC) of SLE patients and healthy volunteers. METHODS: Twenty-two SLE patients and 18 age-matched healthy volunteers were included in this study. The analysis for NK and NKT cells fraction in PBMCs of patients and normal controls were performed by flow cytometric analysis. In addition, to explore the functional status of these cells in SLE patients, we stimulated PBMCs using phorbol ester and ionomycin and measured cytoplasmic IL-4 and IFN-gamma by flow cytometry. RESULTS: The number (percentage) of NK cells was lower in SLE patients (CD3-CD56+: 4.93+/-1.30%, CD3-CD94+: 4.03+/-1.00%) than in controls (11.28+/-1.77%, 8.15+/-1.40%; p< 0.01, respectively). Peripheral NK cell numbers negatively correlated with anti-dsDNA Ab levels (r=-0.431, p< 0.05) and ESR (r= -0.475, p< 0.05). However, the percentage of these cells was not correlated with renal activity or corticosteroid doses. SLE patients showed, compared with controls, significantly decreased numbers of NKT cells (CD3+CD56+: 1.79+/-0.42% vs 5.04+/-0.44%, CD3+CD94+: 1.21+/-0.27% vs 4.39+/-0.45%; p< 0.01, respectively). The cytoplasmic expression of IL-4 and IFN-gamma in NK and NKT cells of SLE patients stimulated using phorbol ester and ionomycin were almost similar to those of normal controls, suggesting the NKT cells from SLE patients are functionally intact. CONCLUSION: Our results suggested that the decreased numbers of immune regulatory cells were associated with the immune dysregulation of SLE patients. The cellular replacement of NKT cells may be one of useful therapeutic approaches for autoimmune diseases such as SLE.
Autoimmune Diseases ; Cytoplasm ; Flow Cytometry ; Healthy Volunteers ; Humans ; Interleukin-4 ; Ionomycin ; Killer Cells, Natural* ; Lupus Erythematosus, Systemic* ; Natural Killer T-Cells

PURPOSE: We first analyzed the prognostic power of albumin-to-alkaline phosphatase ratio (AAPR) before radical radiotherapy (RT) in non-metastatic nasopharyngeal carcinoma (NPC) patients. MATERIALS AND METHODS: The records of 170 patients with biopsy-proven, non-metastatic NPC treated by radical RT between 1998 and 2016 at our institution were retrospectively reviewed. Median follow-up duration was 50.6 months. All patients received intensity-modulated RT and cisplatin based chemotherapy before, during, or after RT. The major treatment of patients was based on concurrent chemoradiotherapy (92.4%). The AAPR was calculated by the last value of both albumin and alkaline phosphatase within 1 month immediately preceding RT. The optimal cut-off level of AAPR was determined by using Cutoff Finder, a web-based system. Propensity score matching (PSM) analysis was performed. RESULTS: The optimal cut-off level of AAPR was 0.4876. After PSM analysis of whole cohort, an AAPR was not related to survival outcomes. In PSM analysis for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC), an AAPR ≥ 0.4876 was related to better overall survival (OS), progression-free survival (PFS), and locoregional relapse–free survival (LRRFS) (OS: hazard ratio [HR], 0.341; 95% confidence interval [CI], 0.144 to 0.805; p=0.014; PFS: HR, 0.416; 95% CI, 0.189 to 0.914; p=0.029; and LRRFS: HR, 0.243; 95% CI, 0.077 to 0.769; p=0.016, respectively). CONCLUSION: The AAPR, inexpensive and readily derived from a routine blood test, could be an independent prognostic factor for patients with LA-NPC. And it might help physicians determine treatment plans by identifying the patient's current status. Future prospective clinical trials to validate its prognostic value are needed.
Alkaline Phosphatase ; Chemoradiotherapy ; Cisplatin ; Cohort Studies ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Hematologic Tests ; Humans ; Prognosis ; Propensity Score ; Prospective Studies ; Radiotherapy ; Retrospective Studies